Colonoscopy Timing After Positive FIT May Be Less Critical Than Ensuring Completion
Delays in colonoscopy following a positive fecal immunochemical test (FIT) may not increase colorectal cancer (CRC) risk within two years, according to a large French nationwide cohort study.
The retrospective analysis included 374,113 individuals with a positive FIT result between 2016 and 2019 who underwent colonoscopy within 24 months. Overall compliance with follow-up colonoscopy was high at 86.6%. During the study period, 21,616 CRCs and 122,359 advanced adenomas were identified.
Investigators compared CRC outcomes based on time to colonoscopy, using a 2- to 3-month interval as the reference. Across extended intervals up to 24 months, there was no significant increase in the risk of CRC, advanced-stage CRC, or advanced adenoma. At 12 months, adjusted odds ratios remained close to unity for all outcomes, indicating no measurable increase in risk compared with earlier colonoscopy.
In contrast, fecal hemoglobin (f-Hb) levels strongly stratified risk. Individuals with f-Hb levels of 200 µg/g or higher were eight times more likely to have CRC and eleven times more likely to have advanced-stage disease compared with those in the lowest f-Hb category.
The authors concluded that “no increased risk of CRC, advanced-stage CRC or AA was observed up to 24 months,” and emphasized that “ensuring colonoscopy compliance after a positive FIT may take precedence over rigid adherence to interval.” They also noted that “the higher the f-Hb, the sooner the colonoscopy should be performed.”
For gastroenterologists, the key takeaway is that while prompt colonoscopy remains important, systems should prioritize ensuring that patients complete follow-up after a positive FIT. Risk stratification using fecal hemoglobin levels may help guide urgency, allowing earlier intervention in higher-risk patients while maintaining flexibility in scheduling for others.
Reference
Grancher A, Denis B, Plaine J, et al. Does a long time to colonoscopy after a positive faecal immunochemical test result have a deleterious impact on colorectal cancer outcomes? A nationwide cohort study. Gut. 2026;75(4):748-759. Published March 6, 2026. doi:10.1136/gutjnl-2025-336036
